Metatarsalgia and Stiff Shoes

Over the past few years, it has become increasingly more common for health

care professionals to refer patients for a “stiff forefoot shoe” in the management of

numerous ball-of-the-foot ailments.

Shoes, particularly athletic ones, are generally designed to be flexible across the

ball of the foot for an efficient toe-off. But every once in a while, and I suspect not by

design, the forefoot is very inflexible. We certainly don’t want all shoes to be this firm,

but a selection across activity groupings proves useful.

When a comfortable shoe or sandal cannot be found that is stiff enough, the

prescription may call for a spring plate to be added, either under the removable footbed

or permanently lodged in the midsole of the shoe. The former, otherwise known as a

transferable spring plate, can be moved from shoe to shoe as long as there is enough

depth to ensure ample room in the toe box. There must also be a removable insole to

put this contoured graphite plate under, keeping it away from direct contact with the foot.

When fit properly, the forefoot almost feels splinted and flex at the ball of the foot is

minimal.

Some individuals don’t take well to the insert under the footbed and will require it

to be permanently lodged in the midsole of the shoe. The disadvantages of the

permanent route are price and the inability to move the plate from shoe to shoe. The

advantage, however, is one can buy the shoe as is for fit and style, while almost

completely eliminating flexibility.

Remember that stiff shoes do have a greater chance of heel slippage. As the

foot tries to flex, the inflexible shoe is left behind. This is particularly prevalent with a

slip-on shoe, often referred to as “slip-offs” because the addition of a spring plate can

make them almost impossible to keep on.

Along with the request for stiffness, the prescription often comes with the request

for a rocker profile or a simple toe spring to aid in toe off. This turned-up toe feature or

toe spring has become a common feature in the design of many running shoes, as well

as some walking models. Customers often describe an unusual feeling of their “toes

falling off the end of the shoe” as they push off. True rocker soles can be added to most

shoes if desired, either by delaminating the outersole or by band sawing the midsole and

inserting it in the body of the shoe.

The following is a review of some of the stiffer shoes in a number of activity

categories that are used to fill prescriptions issued for stiff footwear in the management

of hallux limitus, forefoot neuromas and general metatarsalgia. Hopefully, this will spark

some discussion about the use of stiff shoes and spring plates in the care of those

suffering from pain in the forefoot area.

If you have any questions, comments or would like us to come by and show you

these items, please do not hesitate to call.

Note - The next lecture in the LadySport lecture series will be on February 2003 and will

be a new format clinical lecture with multidiscipline input.

Sponsered by http://www.ladysport.ca/

Early Eating Habits 

 

Culture, especially entertainment culture, is an incredibly powerful ‘influencer’ of nutrition trends and opinions. If your children watch Saturday morning cartoons, perhaps as when you were a child, sit and watch the cartoons and the commercials for an hour with them; better still, bring a pen and paper and list every healthy food and every unhealthy food commercial. The nutrition message delivered in almost every commercial break is an unsound one, although each breakfast cereal, waffle mix or breakfast sausage tries to masquerade as a wise food choice. Parental lifestyles also influence children’s eating habits. Eating on the run, grabbing a take-out meal at the last minute, or a skipped breakfast because you ‘just don’t have time’, all have an effect on how children perceive the value of taking the time to plan, prepare, and enjoy the meals and snacks that keep us living in optimum physical wellness.

If you don’t consistently make wise nutrition choices, chances are your children will make even worse choices, as clever marketing is passed for nutritional advice in mainstream media and a generation is left with few role models worth emulating. Some children like trying new foods...they are in the minority. Most children have a natural aversion to new foods, especially vegetables, especially broccoli, and especially, especially Brussels sprouts. And every Mom and Dad has a plan to entice their young reluctant ones to try, or continue to try, vegetables not to their liking with varying degrees of success. One idea that you might want to put in practice is to take your children grocery shopping with you, using the time in the store to teach your kids. Rather than simply telling them about how to shop with nutrition in mind, enlist their help. Teach them what to look for when they pick a head of broccoli, or a when they choose a small bag of Brussels sprouts. When it’s time to prepare the meal, enlist their help again in the washing (explaining to them why you wash the vegetables), cutting, and cooking of the vegetables they’ve carefully chosen, explaining what nutrients are in the vegetable and why the vegetable is important nutritionally. Let them have a few raw pieces to eat while you are talking and preparing. By including and teaching this way, most children will put aside their reluctance to try new vegetables. For those with young children, you’re probably thinking, “like I have time to do all that!” as you scramble to find enough time in each day as it is. Having been there, we know how you feel. We felt the same at the time. But looking back gives perspective, wisdom, and a wish for certain ‘do-overs’, only this time we would spend less time on things that, in hindsight, really don’t matter much at all, while focusing more time on the fleeting gift that is parenthood. When we are young children, we assume in all but the most extreme cases that the food choices of our parents are a proper and healthy way to eat and maintain a healthy lifestyle. When our parents make poor nutrition choices out of economic necessity or simply not knowing differently, then we grow into adulthood, have children of our own, and repeat the cycle of teaching our children by bad example. Breaking that chain will be a generational gift, teaching your children, and their children in turn, how to make wise nutrition choices that will serve them for life. Educating yourself and teaching your children the value of good food choices and supplements becomes the bolt cutter that breaks the chain, making it worth the effort searching and sifting the internet or the library for quality nutrition and wellness information. The articles and papers you will read in your research will be a basis upon which you can plan, write, and implement a family nutrition wellness program that, over the course of time, you and your family will refine, as the needs and goals and circumstances of each family member change. Learning any new skill is absorbed best while we are still young. By teaching our children healthy eating practices while they are in their formative years, they will grasp and quickly build on the knowledge that you give them. That wellness lifestyle, passed along to coming generations, may well be a most treasured family legacy many decades from now. For your sake in the ‘here and now’, and to set an example that can have a tremendous generational wellness impact, give it a go.

Sponsored by: http://fitnesstown.greenmaplewellness.net/new/articles/article.html?artid=1283